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1.
J Clin Sleep Med ; 2020 Feb 11.
Artigo em Inglês | MEDLINE | ID: mdl-32043960

RESUMO

STUDY OBJECTIVES: The association of mild obstructive sleep apnoea (OSA) with important clinical outcomes remains unclear. We aimed to investigate the association between mild OSA and systemic arterial hypertension (SAH) in the European Sleep Apnoea Database (ESADA) cohort. METHODS: In a multicentre sample of 4732 patients we analyzed the risk of mild OSA (sub-classified into two groups: mildAHI 5-<11/h (apnoea-hypopnoea frequency/hour [AHI] 5 to <11/h) and mildAHI 11-<15/hOSA (AHI ≥11 to <15/h ) compared to non-apnoeic snorers for prevalent SAH after adjustment for relevant confounding factors including gender, age, smoking, obesity, daytime sleepiness, dyslipidaemia, chronic obstructive pulmonary disease, type 2 diabetes and sleep test methodology [polygraphy (PG) or polysomnography (PSG)]. RESULTS: SAH prevalence was higher in the mildAHI 11-<15/h OSA group compared with the mildAHI 5-<11/h group and non-apnoeic snorers (52 vs 45 vs 30%, p<0.001). Corresponding adjusted Odds Ratios (OR) for SAH were 1.789 (mildAHI 11-<15/h, 95% confidence interval [CI] 1.49-2.15) and 1.558 (mildAHI 5-<11/h, 95%, CI 1.34-1.82), respectively; p<0.001. In sensitivity analysis, mildAHI 11-<15/h OSA remained a significant predictor for SAH both in PG (OR = 1.779, 95% CI 1.403-2.256; p<0.001) and PSG group (OR = 1.424, 95% CI 1.047-1.939; p=0.025). CONCLUSION: Our data suggest a dose response relationship between mild OSA and SAH risk, starting from 5 events/hour in PG-recordings and continuing with a further risk increase in the 11 to <15 range. These findings potentially introduce a challenge to traditional thresholds of OSA severity and may help to stratify OSA patients according to cardiovascular risk.

2.
J Sleep Res ; 29(1): e12889, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31257666

RESUMO

The high prevalence of obstructive sleep apnea has led to increasing interest in ambulatory diagnosis. The SleepMinder™ (SM) is a novel non-contact device that employs radiofrequency wave technology to assess the breathing pattern, and thereby estimate obstructive sleep apnea severity. We assessed the performance of SleepMinder™ in the home diagnosis of obstructive sleep apnea. One-hundred and twenty-two subjects were prospectively recruited in two protocols, one from an unselected sleep clinic cohort (n = 67, mean age 51 years) and a second from a hypertension clinic cohort (n = 55, mean age 58 years). All underwent 7 consecutive nights of home monitoring (SMHOME ) with the SleepMinder™ as well as inpatient-attended polysomnography in the sleep clinic cohort or cardiorespiratory polygraphy in the hypertension clinic cohort with simultaneous SleepMinder™ recordings (SMLAB ). In the sleep clinic cohort, median SMHOME apnea-hypopnea index correlated significantly with polysomnography apnea-hypopnea index (r = .68; p < .001), and in the hypertension clinic cohort with polygraphy apnea-hypopnea index (r = .7; p < .001). The median SMHOME performance against polysomnography in the sleep clinic cohort showed a sensitivity and specificity of 72% and 94% for apnea-hypopnea index ≥ 15. Device performance was inferior in females. In the hypertension clinic cohort, SMHOME showed a 50% sensitivity and 72% specificity for apnea-hypopnea index ≥ 15. SleepMinder™ classified 92% of cases correctly or within one severity class of the polygraphy classification. Night-to-night variability in home testing was relatively high, especially at lower apnea-hypopnea index levels. We conclude that the SleepMinder™ device provides a useful ambulatory screening tool, especially in a population suspected of obstructive sleep apnea, and is most accurate in moderate-severe obstructive sleep apnea.

4.
Ir J Med Sci ; 2019 Nov 12.
Artigo em Inglês | MEDLINE | ID: mdl-31721041

RESUMO

BACKGROUND: Subjects with severe obesity (BMI > 40 kg/m2) have worse physical function and sleep less than lean people (BMI 18.5-25 kg/m2). METHODS: In 554 subjects with severe obesity, we compared physical function in those with normal sleep duration (NSD, 6-9 h/night), short sleep duration (SSD, ≤ 6 h/night) and long sleep duration (LSD, ≥ 9 h/night). RESULTS: The mean (±SD) age and BMI were 43.1 (± 11.1) years and 50.9 ± 8.6 kg/m2 respectively. One hundred ninety-six (35.4%) were male. More subjects in the NSD group (n = 256) were able to ascend and descend a step 50 times than in the SSD group (n = 247) or the LSD group (n = 51, 75.5% vs 62.8% vs 56.9%, p = 0.002). A similar observation was made for step speed (0.45 ± 0.11 vs 0.43 ± 0.10 vs 0.40 ± 0.11 steps/s respectively, p = 0.001). NSD participants were less likely to have fallen in the preceding year compared to LSD participants (21.1% vs 39.2%, p = 0.007) and also reported less low back pain compared to SSD participants (60.8% vs 75.9%, p = 0.004). CONCLUSIONS: In conclusion, abnormal sleep duration is associated with reduced physical function in non-elderly severely obese subjects. The effects of sleep hygiene interventions in this cohort warrant further assessment and may be beneficial to their physical function.

5.
J Sleep Res ; 28(6): e12923, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31691457
6.
Sleep Med Clin ; 14(4): 491-498, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31640877

RESUMO

Sleepiness accounts for approximately 20% of major highway motor vehicle accidents (MVAs) and the most common medical disorder associated with sleepiness is obstructive sleep apnea (OSA). OSA patients are 2 to 3 times more likely to have an MVA than the general population, although continuous positive airway pressure therapy can remove this excess risk. Several jurisdictions have introduced regulations to limit driving in patients with moderate or severe OSA associated with sleepiness until the disorder is effectively treated. Successful implementation of such regulations requires education regarding risk-benefit relationships of relevant stakeholders, including patients, clinicians, and employers in the transportation industry.


Assuntos
Acidentes de Trânsito , Condução de Veículo , Pressão Positiva Contínua nas Vias Aéreas , Apneia Obstrutiva do Sono/terapia , Sonolência , Humanos , Apneia Obstrutiva do Sono/fisiopatologia
7.
Sleep Med Clin ; 14(4): xiii-xiv, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31640879
8.
Eur Respir Rev ; 28(153)2019 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-31554703

RESUMO

COPD and obstructive sleep apnoea (OSA) are highly prevalent and different clinical COPD phenotypes that influence the likelihood of comorbid OSA. The increased lung volumes and low body mass index (BMI) associated with the predominant emphysema phenotype protects against OSA whereas the peripheral oedema and higher BMI often associated with the predominant chronic bronchitis phenotype promote OSA. The diagnosis of OSA in COPD patients requires clinical awareness and screening questionnaires which may help identify patients for overnight study. Management of OSA-COPD overlap patients differs from COPD alone and the survival of overlap patients treated with nocturnal positive airway pressure is superior to those untreated. Sleep-related hypoventilation is common in neuromuscular disease and skeletal disorders because of the effects of normal sleep on ventilation and additional challenges imposed by the underlying disorders. Hypoventilation is first seen during rapid eye movement (REM) sleep before progressing to involve non-REM sleep and wakefulness. Clinical presentation is nonspecific and daytime respiratory function measures poorly predict nocturnal hypoventilation. Monitoring of respiration and carbon dioxide levels during sleep should be incorporated in the evaluation of high-risk patient populations and treatment with noninvasive ventilation improves outcomes.

9.
J Clin Sleep Med ; 15(7): 957-963, 2019 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-31383232

RESUMO

STUDY OBJECTIVES: Systemic hypertension is highly prevalent in obstructive sleep apnea (OSA) but there are limited data on OSA prevalence in cohorts with hypertension comparing dippers and nondippers. We investigated this relationship in a clinic-based cohort of patients with hypertension who were not screened for any pretest possibility of OSA. METHODS: A total of 100 patients with hypertension aged (mean ± SD) 58 ± 10 years, body mass index 30.5 ± 6.1 kg/m2, and Epworth Sleepiness Scale score 6 ± 4 were included. All underwent overnight attended sleep studies and 24-hour ambulatory blood pressure monitoring. The primary study end-point was OSA prevalence based on the standard criteria of apnea-hypopnea index (AHI) ≥ 15 events/h in patients with dipping and nondipping nocturnal blood pressure. RESULTS: Results showed 10.5% of dippers and 43.5% of nondippers had an AHI ≥ 15 (chi-square P = .001). In univariate analysis, AHI correlated significantly with blood pressure dip (r = -.26, P < .05), as did ESS (r = -.28, P < .05). In linear regression, AHI predicted the magnitude of blood pressure dip (standardised ß = -.288, P = .03), whereas age, body mass index, systolic blood pressure and diastolic blood pressure did not. CONCLUSIONS: Patients with nondipping nocturnal blood pressure are at high risk of OSA, regardless of symptom profile, which supports the recommendation that such patients should be assessed for co-existing OSA.

12.
Expert Rev Respir Med ; 13(3): 251-261, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30691323

RESUMO

INTRODUCTION: Obstructive sleep apnoea (OSA) is highly prevalent and there is considerable evidence supporting an independent association with a wide range of co-morbidities including cardiovascular, endocrine and metabolic, neuropsychiatric, pulmonary, and renal. Areas covered: A PubMed search of all the recent literature relating to OSA and co-morbidities was undertaken to critically evaluate the potential relationships and possible benefit of continuous positive airway pressure (CPAP) therapy. Expert commentary: The evidence supporting an independent association is stronger for some co-morbidities than others and in cardiovascular diseases is strongest for hypertension and atrial fibrillation. Potential mechanisms include intermittent hypoxia, fluctuating intrathoracic pressure, and recurring micro-arousals that trigger cell and molecular consequences including sympathetic excitation, systemic inflammation and oxidative stress, in addition to metabolic and endothelial dysfunction. Different mechanisms may predominate in individual co-morbidities. Recent long term randomised controlled trials have cast doubt on benefits to co-morbidities from CPAP therapy of OSA, especially where co-morbidities are already established. However, benefits may result in patients who are compliant with therapy and further research is required to clearly establish the role of OSA therapy in both primary and secondary prevention of co-morbidities.

16.
J Sleep Res ; 27(6): e12729, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-29998568

RESUMO

Obstructive sleep apnea (OSA) and asthma are often associated and several studies suggest a bidirectional relationship between asthma and OSA. This study analyzed the characteristics of patients with suspected OSA from the European Sleep Apnea Database according to presence/absence of physician-diagnosed asthma. Cross-sectional data in 16,236 patients (29.1% female) referred for suspected OSA were analyzed according to occurrence of physician-diagnosed asthma for anthropometrics, OSA severity and sleepiness. Sleep structure was assessed in patients studied by polysomnography (i.e. 48% of the sample). The prevalence of physician-diagnosed asthma in the entire cohort was 4.8% (7.9% in women, 3.7% in men, p < 0.0001), and decreased from subjects without OSA to patients with mild-moderate and severe OSA (p = 0.02). Obesity was highly prevalent in asthmatic women, whereas BMI distribution was similar in men with and without physician-diagnosed asthma. Distribution of OSA severity was similar in patients with and without physician-diagnosed asthma, and unaffected by treatment for asthma or gastroesophageal reflux. Asthma was associated with poor sleep quality and sleepiness. Physician-diagnosed asthma was less common in a sleep clinic population than expected from the results of studies in the general population. Obesity appears as the major factor raising suspicion of OSA in asthmatic women, whereas complaints of poor sleep quality were the likely reason for referral in asthmatic men.


Assuntos
Asma/diagnóstico , Asma/epidemiologia , Papel do Médico , Autorrelato , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/epidemiologia , Adulto , Idoso , Asma/fisiopatologia , Estudos de Coortes , Estudos Transversais , Europa (Continente)/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Polissonografia/métodos , Estudos Prospectivos , Apneia Obstrutiva do Sono/fisiopatologia
17.
Eur Respir J ; 52(3)2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29853491

RESUMO

Obstructive sleep apnoea (OSA) is a major challenge for physicians and healthcare systems throughout the world. The high prevalence and the impact on daily life of OSA oblige clinicians to offer effective and acceptable treatment options. However, recent evidence has raised questions about the benefits of positive airway pressure therapy in ameliorating comorbidities.An international expert group considered the current state of knowledge based on the most relevant publications in the previous 5 years, discussed the current challenges in the field, and proposed topics for future research on epidemiology, phenotyping, underlying mechanisms, prognostic implications and optimal treatment of patients with OSA.The group concluded that a revision to the diagnostic criteria for OSA is required to include factors that reflect different clinical and pathophysiological phenotypes and relevant comorbidities (e.g. nondipping nocturnal blood pressure). Furthermore, current severity thresholds require revision to reflect factors such as the disparity in the apnoea-hypopnoea index (AHI) between polysomnography and sleep studies that do not include sleep stage measurements, in addition to the poor correlation between AHI and daytime symptoms such as sleepiness. Management decisions should be linked to the underlying phenotype and consider outcomes beyond AHI.


Assuntos
Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/terapia , Comorbidade , Europa (Continente) , Humanos , Polissonografia , Sociedades Médicas
18.
J Thorac Dis ; 10(3): 1941-1950, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29707350

RESUMO

Background: Standard management has been recommended for obstructive sleep apnea (OSA) by several guidelines, but patient choice in the practical setting is unclear. Methods: A survey nested in two prospective cohort studies of OSA (enrollment: 2001-2010) in China. The last interview was conducted between July 2014 and May 2015, using a comprehensive 10-point questionnaire administered in a face-to-face or telephone interview, and assessed (I) whether the participant had received any OSA treatment; (II) why he or she had decided for or against treatment; (III) what treatment was received; (IV) whether the participant used continuous positive airway pressure (CPAP) or OA daily; and (V) the perceived efficacy of therapy. Results: A total of 4,097 subjects with a mean age of 45 years [37-55] responded to this survey, with a response rate of 79.4% (4,097/5,160); 2,779 subjects (67.8%) did not receive any treatment: 1,485 (53.4%) believed that their condition was not serious, despite severe OSA in 53.7% of the patients. A multivariate regression showed that the decision to receive treatment was associated with: age between 45-59 years [odds ratio (OR) 0.805, 95% CI: 0.691-0.936; P<0.001], female gender (OR 0.492, 95% CI: 0.383-0.631; P<0.001), severe OSA (OR 1.92, 95% CI: 1.01-3.64; P<0.001), hypertension (OR 1.414, 95% CI: 1.209-1.654; P<0.001) and diabetes (OR 1.760, 95% CI: 1.043-2.972; P=0.034). In subjects receiving treatment (n=1,318), 50.9% reported negative perceptions about the treatments. Conclusions: Nearly two thirds of Chinese patients choose not to receive treatment after OSA diagnosis, and nearly half are negative about their treatments for OSA. This requires clinical attention, and warrants further study in different geographic settings.

19.
Chest ; 154(2): 326-334, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29698721

RESUMO

BACKGROUND: The impact of treating OSA on renal function decline is controversial. Previous studies usually included small samples and did not consider specific effects of different CPAP modalities. The aim of this study was to evaluate the respective influence of fixed and autoadjusting CPAP modes on estimated glomerular filtration rate (eGFR) in a large sample of patients derived from the prospective European Sleep Apnea Database cohort. METHODS: In patients of the European Sleep Apnea Database, eGFR prior to and after follow-up was calculated by using the Chronic Kidney Disease-Epidemiology Collaboration equation. Three study groups were investigated: untreated patients (n = 144), patients receiving fixed CPAP (fCPAP) (n = 1,178), and patients on autoadjusting CPAP (APAP) (n = 485). RESULTS: In the whole sample, eGFR decreased over time. The rate of eGFR decline was significantly higher in the subgroup with eGFR above median (91.42 mL/min/1.73 m2) at baseline (P < .0001 for effect of baseline eGFR). This decline was attenuated or absent (P < .0001 for effect of treatment) in the subgroup of patients with OSA treated by using fCPAP. A follow-up duration exceeding the median (541 days) was associated with eGFR decline in the untreated and APAP groups but not in the fCPAP group (P < .0001 by two-way ANOVA for interaction between treatment and follow-up length). In multiple regression analysis, eGFR decline was accentuated by advanced age, female sex, cardiac failure, higher baseline eGFR, and longer follow-up duration, whereas there was a protective effect of fCPAP. CONCLUSIONS: fCPAP but not APAP may prevent eGFR decline in OSA.


Assuntos
Pressão Positiva Contínua nas Vias Aéreas/métodos , Taxa de Filtração Glomerular , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/terapia , Europa (Continente) , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Polissonografia , Estudos Prospectivos , Sistema de Registros , Fatores de Risco
20.
J Thorac Dis ; 10(1): 531-533, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29600089
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